Ontario doctor who induced labour without patients’ consent loses right to practise

An obstetrician who admitted to inducing labour in numerous patients without their knowledge or consent violated core tenets of the profession and denied women in his care some of their basic rights, Ontario’s medical regulator ruled as it revoked the doctor’s right to practise in the province.

The College of Physicians and Surgeons of Ontario said Dr. Paul Shuen routinely administered medication to induce labour without discussing the matter with his patients. An agreed statement of facts also said Shuen denied doing so on multiple occasions before confessing that he’d engaged in the practice for more than a decade.

“The committee finds Dr. Shuen’s actions to be egregious, highly offensive, and intolerable,” the college said in a decision released this week. “His actions in placing patients at potential harm, his untruthfulness, and his placement of self-interest above his patient’s best interest are contrary to the fundamental values of the medical profession.”

Lawyers representing Shuen declined to comment on the college’s ruling and disciplinary measures, which include revoking his certification and a fine of more than $40,000.

Shuen, 69, had been an obstetrician with privileges at the North York General Hospital in north Toronto.

According to the agreed statement of facts presented in the college’s decision, concerns first arose in 2013 when a nurse found a white, powdery tablet in the vagina of one of Shuen’s patients. The medication was suspected to be misoprostol, which induces uteran contractions, though analysis was not performed on the pill at that time.

The same thing happened again in August 2015, the college said, adding Shuen denied administering the medication on both occasions.

The 2013 patient’s medical chart did not indicate any orders for misoprostol, and the 2015 patient told the hospital she had not consented to having the medication administered.

Further concerns arose one day in May 2016 when five of Dr. Shuen’s patients all arrived at the hospital with rapid labours. An incident report filed that day raised questions about whether labour was being induced at Shuen’s office, noting the surge of patients was unusual.

One of the patients required an immediate cesarean section, the report noted, adding that if induction measures were being used at the office, the approach would fall “outside of best practices with respect to monitoring for patients.”

Weeks later another patient came to hospital in advanced labour, a circumstance that surprised staff given it was the woman’s first birth. The hospital launched an investigation after a nurse completed an internal exam and found white pill fragments.

The investigation involved conducting chemical analyses on the pills recovered from patients in 2015 and 2016, which determined the pills were misoprostol tablets.

Shuen continued to deny administering the medication even after being confronted with the analysis evidence, the college said, adding he only admitted to the practice after learning he could have his hospital privileges revoked.

At that time, the college said, he confessed to inducing labour in multiple patients for more than a decade. Shuen said he did not discuss this step with his patients, nor did he obtain their consent for the inductions, document his use of misoprostol in their medical charts, or monitor them after administering the medication.

“The impact of Dr. Shuen’s behaviour on obstetrical patients who are particularly vulnerable when close to delivery cannot be minimized,” the college said in its decision. “No woman should ever have to question being treated surreptitiously and without consent … He denied them a fundamental patient right, the right to choose.”

The college said Shuen offered several reasons for his actions, including a wish to bypass hospital bureaucracy as well as “financial gain.” One billing model prevalent in the province involves doctors being paid for each procedure they complete, though the decision did not specify whether this was the approach being used in Shuen’s office.

The college also took Shuen to task for placing unnecessary stress and burden on hospital staff during the 2016 influx of rapid labours.

In finding that Shuen had failed to maintain necessary professional standards, the college said revoking his certification to practice in Ontario was a necessary step.

“Dr. Shuen has demonstrated by his actions that he cannot be trusted and is not worthy of the trust invested by the public in the medical profession,” the decision reads.

“Revocation is necessary to uphold the reputation of the profession and to ensure that the public has confidence that physicians will follow accepted standards of practice and act with honesty and integrity.”